scholarly journals Improving delivery of care in rural emergency departments: a qualitative pilot study mobilizing health professionals, decision-makers and citizens in Baie-Saint-Paul and the Magdalen Islands, Québec, Canada

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Richard Fleet ◽  
Catherine Turgeon-Pelchat ◽  
Mélanie Ann Smithman ◽  
Hassane Alami ◽  
Jean-Paul Fortin ◽  
...  
Keyword(s):  
Pilot Study ◽  
Health Professionals ◽  
Emergency Departments ◽  
Saint Paul ◽  
Decision Makers ◽  
Delivery Of Care ◽  
Magdalen Islands

scholarly journals Physician Workflow in Two Distinctive Emergency Departments: An Observational Study

2021 ◽  
Vol 12 (01) ◽  
pp. 141-152
Author(s):  
Vimla L. Patel ◽  
Courtney A. Denton ◽  
Hiral C. Soni ◽  
Thomas G. Kannampallil ◽  
Stephen J. Traub ◽  
...  
Keyword(s):  
Patient Care ◽  
Emergency Departments ◽  
Direct Patient Care ◽  
Team Communication ◽  
Delivery Of Care ◽  
Physician Practices ◽  
Clinical Observations ◽  
Workflow Pattern ◽  
Open Coding ◽  
Temporal Events

Abstract Objectives We characterize physician workflow in two distinctive emergency departments (ED). Physician practices mediated by electronic health records (EHR) are explored within the context of organizational complexity for the delivery of care. Methods Two urban clinical sites, including an academic teaching ED, were selected. Fourteen physicians were recruited. Overall, 62 hours of direct clinical observations were conducted characterizing clinical activities (EHR use, team communication, and patient care). Data were analyzed using qualitative open-coding techniques and descriptive statistics. Timeline belts were used to represent temporal events. Results At site 1, physicians, engaged in more team communication, followed by direct patient care. Although physicians spent 61% of their clinical time at workstations, only 25% was spent on the EHR, primarily for clinical documentation and review. Site 2 physicians engaged primarily in direct patient care spending 52% of their time at a workstation, and 31% dedicated to EHRs, focused on chart review. At site 1, physicians showed nonlinear complex workflow patterns with a greater frequency of multitasking and interruptions, resulting in workflow fragmentation. In comparison, at site 2, a less complex environment with a unique patient assignment system, resulting in a more linear workflow pattern. Conclusion The nature of the clinical practice and EHR-mediated workflow reflects the ED work practices. Physicians in more complex organizations may be less efficient because of the fragmented workflow. However, these effects can be mitigated by effort distribution through team communication, which affords inherent safety checks.

Quality of service and commitment to tobacco dependence treatment for individuals living with mental disorders in France: A pilot study

2021 ◽  
pp. 002076402110429
Author(s):  
João M Castaldelli-Maia ◽  
Priscila D Gonçalves ◽  
Danielle R Lima ◽  
Helena F Moura ◽  
Gisèle Apter
Keyword(s):  
Mental Health ◽  
Quality Of Service ◽  
Pilot Study ◽  
Mental Disorders ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Tobacco Dependence ◽  
Treatment Quality ◽  
Tobacco Treatment

Background: There are remarkably high smoking rates in patients living with mental disorders (PLWMD), and the absence of a specific treatment policy for smoking cessation for these patients worldwide. The present study aimed to (i) investigate the quality of service and commitment to tobacco dependence treatment, and (ii) produce high-quality French versions of the Index of Tobacco Treatment Quality (ITTQ) and Tobacco Treatment Commitment Scale (TTCS). Methods: ITTQ and TTCS were used to assess French mental health professionals ( n = 80). Both scales were translated from their original language following standard procedures (i.e. forward translation). Descriptive analysis for total score, each factor and item were calculated for the entire sample, followed by subgroup analysis by gender, and role of the practitioner. Results: Nurses presented higher levels of both treatment commitment and treatment quality in their mental health care units, compared to psychiatrists, and residents. Overall, counseling offering was low and there was a perception that it is unfair to take tobacco away from PLWMD. In the other hand, there were high levels of smoking assessment and perceptions that nicotine dependence should be included in drug treatment programs. Conclusions: There is a gap in tobacco treatment implementation for French PLWMD. The present pilot study alerts about the problem, and should stimulate larger studies validating such measures for wide use with French-speaking mental health professionals. French nurses presented higher levels of both treatment commitment and quality, and could be in a leadership position for such implementation. Encouraging the implementation of tobacco counseling within conventional mental health treatment is critical to improve cessation rates among this population. There is a potential for the sustainability of tobacco treatment interventions since the levels of commitment observed here were higher than in previous studies conducted abroad.

Trends in the Contribution of Emergency Departments to the Provision of Hospital-Associated Health Care in the USA

2017 ◽  
Vol 48 (2) ◽  
pp. 267-288 ◽  
Author(s):  
David Marcozzi ◽  
Brendan Carr ◽  
Aisha Liferidge ◽  
Nicole Baehr ◽  
Brian Browne
Keyword(s):  
United States ◽  
Health Care ◽  
Medical Care ◽  
Emergency Departments ◽  
The United States ◽  
National Hospital ◽  
Patient Centered ◽  
National Hospital Discharge Survey ◽  
Delivery Of Care ◽  
The Usa

Traditional approaches to assessing the health of populations focus on the use of primary care and the delivery of care through patient-centered homes, managed care resources, and accountable care organizations. The use of emergency departments (EDs) has largely not been given consideration in these models. Our study aimed to determine the contribution of EDs to the health care received by Americans between 1996 and 2010 and to compare it with the contribution of outpatient and inpatient services using National Hospital Ambulatory Medical Care Survey and National Hospital Discharge Survey databases. We found that EDs contributed an average of 47.7% of the hospital-associated medical care delivered in the United States, and this percentage increased steadily over the 14-year study period. EDs are a major source of medical care in the United States, especially for vulnerable populations, and this contribution increased throughout the study period. Including emergency care within health reform and population health efforts would prove valuable to supporting the health of the nation.

scholarly journals Development of the ACTIVE framework to describe stakeholder involvement in systematic reviews

2019 ◽  
Vol 24 (4) ◽  
pp. 245-255 ◽  
Author(s):  
Alex Pollock ◽  
Pauline Campbell ◽  
Caroline Struthers ◽  
Anneliese Synnot ◽  
Jack Nunn ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Health Professionals ◽  
Public Involvement ◽  
Review Process ◽  
Data Extraction ◽  
Stakeholder Involvement ◽  
Decision Makers ◽  
Literature Searching ◽  
Health Decision

Objectives Involvement of patients, health professionals, and the wider public (‘stakeholders’) is seen to be beneficial to the quality, relevance and impact of research and may enhance the usefulness and uptake of systematic reviews. However, there is a lack of evidence and resources to guide researchers in how to actively involve stakeholders in systematic reviews. In this paper, we report the development of the ACTIVE framework to describe how stakeholders are involved in systematic reviews. Methods We developed a framework using methods previously described in the development of conceptual frameworks relating to other areas of public involvement, including: literature searching, data extraction, analysis, and categorization. A draft ACTIVE framework was developed and then refined after presentation at a conference workshop, before being applied to a subset of 32 systematic reviews. Data extracted from these systematic reviews, identified in a systematic scoping review, were categorized against pre-defined constructs, including: who was involved, how stakeholders were recruited, the mode of involvement, at what stage there was involvement and the level of control or influence. Results The final ACTIVE framework described whether patients, carers and/or families, and/or other stakeholders (including health professionals, health decision makers and funders) were involved. We defined: recruitment as either open or closed; the approach to involvement as either one-time, continuous or combined; and the method of involvement as either direct or indirect. The stage of involvement in reviews was defined using the Cochrane Ecosystem stages of a review. The level of control or influence was defined according to the roles and activities of stakeholders in the review process, and described as the ACTIVE continuum of involvement. Conclusions The ACTIVE framework provides a structure with which to describe key components of stakeholder involvement within a systematic review, and we have used this to summarize how stakeholders have been involved in a subset of varied systematic reviews. The ACTIVE continuum of involvement provides a new model that uses tasks and roles to detail the level of stakeholder involvement. This work has contributed to the development of learning resources aimed at supporting systematic review authors and editors to involve stakeholders in their systematic reviews. The ACTIVE framework may support the decision-making of systematic review authors in planning how to involve stakeholders in future reviews.

scholarly journals Process Improvement Approaches for Increasing the Response of Emergency Departments against the COVID-19 Pandemic: A Systematic Review

2021 ◽  
Vol 18 (16) ◽  
pp. 8814
Author(s):  
Miguel Angel Ortíz-Barrios ◽  
Dayana Milena Coba-Blanco ◽  
Juan-José Alfaro-Saíz ◽  
Daniela Stand-González
Keyword(s):  
Process Improvement ◽  
Emergency Departments ◽  
Decision Makers ◽  
Future Research ◽  
Research Papers ◽  
Improvement Interventions ◽  
Meta Analyses ◽  
Implementing Strategies ◽  
Management Domains

The COVID-19 pandemic has strongly affected the dynamics of Emergency Departments (EDs) worldwide and has accentuated the need for tackling different operational inefficiencies that decrease the quality of care provided to infected patients. The EDs continue to struggle against this outbreak by implementing strategies maximizing their performance within an uncertain healthcare environment. The efforts, however, have remained insufficient in view of the growing number of admissions and increased severity of the coronavirus disease. Therefore, the primary aim of this paper is to review the literature on process improvement interventions focused on increasing the ED response to the current COVID-19 outbreak to delineate future research lines based on the gaps detected in the practical scenario. Therefore, we applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to perform a review containing the research papers published between December 2019 and April 2021 using ISI Web of Science, Scopus, PubMed, IEEE, Google Scholar, and Science Direct databases. The articles were further classified taking into account the research domain, primary aim, journal, and publication year. A total of 65 papers disseminated in 51 journals were concluded to satisfy the inclusion criteria. Our review found that most applications have been directed towards predicting the health outcomes in COVID-19 patients through machine learning and data analytics techniques. In the overarching pandemic, healthcare decision makers are strongly recommended to integrate artificial intelligence techniques with approaches from the operations research (OR) and quality management domains to upgrade the ED performance under social-economic restrictions.

scholarly journals Stakeholders’ Views on Responsible Assessments of Assistive Technologies through an Ethical HTA Matrix

Societies ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. 51
Author(s):  
Thorstensen
Keyword(s):  
Health Professionals ◽  
Assistive Technologies ◽  
Decision Makers ◽  
Health Innovation ◽  
Health Technologies ◽  
Home Based ◽  
Care Workers ◽  
The Matrix ◽  
Gps Localization ◽  
Innovation Processes

Assessments of novel assistive technologies for use in home-based services has been documented to be performed in a variety of ways and often with a rather narrow focus on safety and effect or effectiveness. In order better to understand the place for wider forms of assessments of assistive technologies, the current study presents a combination of the Ethical Matrix and the Socratic approach for assessment of health technologies—the Ethical HTA Matrix. This matrix was filled with content based on a case of a GPS localization system, which was validated by stakeholders. In a next step, central decision-makers in assistive technologies and stakeholders were interviewed concerning their views on this methodology. Mainly, the matrix was seen as very comprehensive, but too detailed with an abundance of information. Nevertheless, some informants suggested concrete uses of the matrix in their organizations. Some understood the matrix more as an epistemic tool aiming at providing an overview of the state of knowledge, while others identified a normative potential in the matrix that could be implemented in health innovation processes for the home-based services, in particular when discussing novel solutions and working methods with health professionals and care workers.

scholarly journals Effectiveness of a Web-Based eHealth Portal for Delivery of Care to Home Dialysis Patients: A Single-Arm Pilot Study

2018 ◽  
Vol 5 ◽  
pp. 205435811879441 ◽  
Author(s):  
James Kiberd ◽  
Usman Khan ◽  
Cynthia Stockman ◽  
Arun Radhakrishnan ◽  
Matthew Phillips ◽  
...  
Keyword(s):  
Pilot Study ◽  
Dialysis Patients ◽  
Web Based ◽  
Home Dialysis ◽  
Delivery Of Care
Sign in / Sign up

Export Citation Format

Share Document